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randomised control trial Emergency medicine

Simon G A Brown, Emma L Ball, Kyle Perrin, Catherine A Read, Stephen E Asha, Richard Beasley, Diana Egerton-Warburton, Peter G Jones, Gerben Keijzers, Frances B Kinnear, Ben C H Kwan, Y C Gary Lee, Julian A Smith, Quentin A Summers, Graham Simpson
INTRODUCTION: Current management of primary spontaneous pneumothorax (PSP) is variable, with little evidence from randomised controlled trials to guide treatment. Guidelines emphasise intervention in many patients, which involves chest drain insertion, hospital admission and occasionally surgery. However, there is evidence that conservative management may be effective and safe, and it may also reduce the risk of recurrence. Significant questions remain regarding the optimal initial approach to the management of PSP...
September 13, 2016: BMJ Open
Lyndall Mollart, Jon Adams, Maralyn Foureur
UNLABELLED: Feasibility randomised controlled trials of complementary medicine are important to evaluate acceptability and practicality. This study examined participants' and health professionals' perceptions of CAM and participation in a feasibility RCT of acupressure for labour onset. METHODS: A qualitative study incorporated within an RCT. Data were collected from postnatal women via questionnaires and health professionals via focus groups. RESULTS: Four themes emerged from the women's views: "Using CAM to start labour", "Feeling empowered through action", "Desiring randomisation to acupressure group", and "Welcoming the opportunity to assist in research"...
August 2016: Complementary Therapies in Clinical Practice
Irina Ghislain, Efstathios Zikos, Corneel Coens, Chantal Quinten, Vasiliki Balta, Konstantinos Tryfonidis, Martine Piccart, Dimitrios Zardavas, Eva Nagele, Vesna Bjelic-Radisic, Fatima Cardoso, Mirjam A G Sprangers, Galina Velikova, Andrew Bottomley
Breast cancer is the leading cause of cancer death among women worldwide, and increasingly, randomised controlled trials of this disease are measuring the health-related quality of life of these patients. In this systematic Review, we assess the adequacy of methods used to report health-related quality of life (HRQOL) from 49 eligible randomised controlled trials of advanced breast cancer. We compare our findings with those from the literature to investigate whether the standard of HRQOL reporting in this field has changed...
July 2016: Lancet Oncology
Lauralyn McIntyre, Brian H Rowe, Timothy S Walsh, Alasdair Gray, Yaseen Arabi, Anders Perner, Anthony Gordon, John Marshall, Deborah Cook, Alison Fox-Robichaud, Sean M Bagshaw, Robert Green, Irwin Schweitzer, Alexis Turgeon, Ryan Zarychanski, Shane English, Michaël Chassé, Ian Stiell, Dean Fergusson
OBJECTIVES: Evidence to guide fluid resuscitation evidence in sepsis continues to evolve. We conducted a multicountry survey of emergency and critical care physicians to describe current stated practice and practice variation related to the quantity, rapidity and type of resuscitation fluid administered in early septic shock to inform the design of future septic shock fluid resuscitation trials. METHODS: Using a web-based survey tool, we invited critical care and emergency physicians in Canada, the UK, Scandinavia and Saudi Arabia to complete a self-administered electronic survey...
2016: BMJ Open
Catherine L Wilson, David Johnson, Ed Oakley
AIM: Systematic review of knowledge translation studies focused on paediatric emergency care to describe and assess the interventions used in emergency department settings. METHODS: Electronic databases were searched for knowledge translation studies conducted in the emergency department that included the care of children. Two researchers independently reviewed the studies. RESULTS: From 1305 publications identified, 15 studies of varied design were included...
February 2016: Journal of Paediatrics and Child Health
Michael K Drew, Caroline F Finch
BACKGROUND: Clinically it is understood that rapid increases in training loads expose an athlete to an increased risk of injury; however, there are no systematic reviews to qualify this statement. OBJECTIVE: The aim of this systematic review was to determine training and competition loads, and the relationship between injury, illness and soreness. METHODS: The MEDLINE, SPORTDiscus, CINAHL and EMBASE databases were searched using a predefined search strategy...
June 2016: Sports Medicine
Amy Johnston, Louisa Abraham, Jaimi Greenslade, Ogilvie Thom, Eric Carlstrom, Marianne Wallis, Julia Crilly
Employees in EDs report increasing role overload because of critical staff shortages, budgetary cuts and increased patient numbers and acuity. Such overload could compromise staff satisfaction with their working environment. This integrative review identifies, synthesises and evaluates current research around staff perceptions of the working conditions in EDs. A systematic search of relevant databases, using MeSH descriptors ED/EDs, Emergency room/s, ER/s, or A&E coupled with (and) working environment, working condition/s, staff perception/s, as well as reference chaining was conducted...
February 2016: Emergency Medicine Australasia: EMA
Patrick F Chinnery
Ten years ago, there was an emerging view that the molecular basis for adult mitochondrial disorders was largely known and that the clinical phenotypes had been well described. Nothing could have been further from the truth. The establishment of large cohorts of patients has revealed new aspects of the clinical presentation that were not previously appreciated. Over time, this approach is starting to provide an accurate understanding of the natural history of mitochondrial disease in adults. Advances in molecular diagnostics, underpinned by next generation sequencing technology, have identified novel molecular mechanisms...
November 26, 2015: EMBO Molecular Medicine
Philip J Wiffen, Sheena Derry, Katrien Naessens, Rae F Bell
BACKGROUND: A large proportion of people with advanced cancer will experience moderate to severe pain. Tapentadol is a novel, centrally acting analgesic medicine acting at the μ-opioid receptor and inhibiting noradrenaline reuptake. The efficacy of tapentadol is stated to be comparable to morphine and oxycodone. OBJECTIVES: To assess the analgesic efficacy of tapentadol for the relief of cancer pain in adults, and the adverse events associated with its use in clinical trials...
2015: Cochrane Database of Systematic Reviews
Kevin P Daly
Heart transplantation offers excellent survival benefit to children with end-stage heart failure. With its success, the number of potential recipients continues to exceed the number of available donors. Developing strategies to safely increase donor utilisation is crucial to decreasing wait-list mortality. A new paediatric heart allocation policy is set to be implemented with the goal of prioritising the most urgent listed candidates. Owing to excellent outcomes of ABO-incompatible heart transplantation, the sickest infants will soon receive priority for heart offers irrespective of blood group...
August 2015: Cardiology in the Young
Robert Pickard, Kathryn Starr, Graeme MacLennan, Mary Kilonzo, Thomas Lam, Ruth Thomas, Jennifer Burr, John Norrie, Gladys McPherson, Alison McDonald, Kirsty Shearer, Katie Gillies, Kenneth Anson, Charles Boachie, James N'Dow, Neil Burgess, Terry Clark, Sarah Cameron, Samuel McClinton
BACKGROUND: Ureteric colic, the term used to describe the pain felt when a stone passes down the ureter from the kidney to the bladder, is a frequent reason for people to seek emergency health care. Treatment with the muscle-relaxant drugs tamsulosin hydrochloride (Petyme, TEVA UK Ltd) and nifedipine (Coracten(®), UCB Pharma Ltd) as medical expulsive therapy (MET) is increasingly being used to improve the likelihood of spontaneous stone passage and lessen the need for interventional procedures...
August 2015: Health Technology Assessment: HTA
Maysam Ali Abdulwahid, Andrew Booth, Maxine Kuczawski, Suzanne M Mason
STUDY QUESTION: To determine if placing a senior doctor at triage versus standard single nurse in a hospital emergency department (ED) improves ED performance by reviewing evidence from comparative design studies using several quality indicators. DESIGN: Systematic review. DATA SOURCES: Cochrane Library, MEDLINE, EMBASE, CINAHL, Cochrane Effective Practice and Organisation of Care (EPOC), Web of Science, Clinical Trials Registry website. In addition, references from included studies and citation searches were used to identify relevant studies...
July 2016: Emergency Medicine Journal: EMJ
Catherine D Darker, Brion P Sweeney, Joe M Barry, Michael F Farrell, Erica Donnelly-Swift
BACKGROUND: Benzodiazepines (BZDs) have a sedative and hypnotic effect upon people. Short term use can be beneficial but long term BZD use is common, with several risks in addition to the potential for dependence in both opiate and non-opiate dependent patients. OBJECTIVES: To evaluate the effectiveness of psychosocial interventions for treating BZD harmful use, abuse or dependence compared to pharmacological interventions, no intervention, placebo or a different psychosocial intervention on reducing the use of BZDs in opiate dependent and non-opiate dependent groups...
May 11, 2015: Cochrane Database of Systematic Reviews
Catherine D Darker, Brion P Sweeney, Joe M Barry, Michael F Farrell, Erica Donnelly-Swift
BACKGROUND: Benzodiazepines (BZDs) have a sedative and hypnotic effect upon people. Short term use can be beneficial but long term BZD use is common, with several risks in addition to the potential for dependence in both opiate and non-opiate dependent patients. OBJECTIVES: To evaluate the effectiveness of psychosocial interventions for treating BZD harmful use, abuse or dependence compared to pharmacological interventions, no intervention, placebo or a different psychosocial intervention on reducing the use of BZDs in opiate dependent and non-opiate dependent groups...
2015: Cochrane Database of Systematic Reviews
Gina Agarwal, Beatrice McDonough, Ricardo Angeles, Melissa Pirrie, Francine Marzanek, Brent McLeod, Lisa Dolovich
INTRODUCTION: Chronic diseases and falls substantially contribute to morbidity/mortality among seniors, causing this population to frequently seek emergency medical care. Research suggests the paramedic role can be successfully expanded to include community-based health promotion and prevention. This study implements a community paramedicine programme targeting seniors in subsidised housing, a high-risk population and frequent users of emergency medical services (EMS). The aims are to reduce EMS calls, improve health outcomes and healthcare utilisation...
2015: BMJ Open
Brandon Hankey, Brad Riley
A shortcut review was carried out to establish whether a procalcitonin-guided algorithm could safely reduce antibiotic consumption for patients with an exacerbation of chronic obstructive pulmonary disease attending the emergency department. Four randomised controlled trials were found directly relevant to the three-part question, combined within a later systematic review and meta-analysis. A further prospective cohort study was also found relevant to the three-part question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated...
June 2015: Emergency Medicine Journal: EMJ
Catherine Weber, Jerome Stirnemann, François R Herrmann, Sophie Pautex, Jean-Paul Janssens
BACKGROUND: COPD is a progressive lung disorder with rates of mortality between 36-50%, within 2 years after admission for an acute exacerbation. While treatment with inhaled bronchodilators and steroids may partially relieve symptoms and oxygen therapy may prolong life, for many patients the course of the disease is one of inexorable decline. Very few palliative care intervention studies are available for this population. This trial seeks to determine the effectiveness of the introduction of specialized palliative care on hospital, intensive care unit and emergency admissions of patients with severe and very severe COPD...
2014: BMC Palliative Care
Gavin D Smith, Meagan M Fry, David Taylor, Amee Morgans, Kate Cantwell
BACKGROUND: People with the cardiac arrhythmia supraventricular tachycardia (SVT) frequently present to clinicians in the prehospital and emergency medicine settings. Restoring sinus rhythm by terminating the SVT involves increasing the refractoriness of atrioventricular nodal tissue within the myocardium by means of vagal manoeuvres, pharmacological agents, or electrical cardioversion. A commonly used first-line technique to restore the normal sinus rhythm (reversion) is the Valsalva Manoeuvre (VM)...
2015: Cochrane Database of Systematic Reviews
John M Wiecha, William G Adams, Denis Rybin, Maria Rizzodepaoli, Jeremy Keller, Jayanti M Clay
BACKGROUND: Asthma is the most common chronic condition of childhood and disproportionately affects inner-city minority children. Low rates of asthma preventer medication adherence is a major contributor to poor asthma control in these patients. Web-based methods have potential to improve patient knowledge and medication adherence by providing interactive patient education, monitoring of symptoms and medication use, and by facilitation of communication and teamwork among patients and health care providers...
2015: BMC Pulmonary Medicine
Kirk R Wilhelmus
BACKGROUND: Eye disease due to herpes simplex virus (HSV) commonly presents as epithelial keratitis which, though usually self-limiting, may persist or progress without treatment. OBJECTIVES: To compare the relative effectiveness of antiviral agents, interferon, and corneal debridement in the treatment of HSV epithelial keratitis. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 12), PubMed (January 1946 to 31 December 2014), EMBASE (January 1980 to 31 December 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to 31 December 2014), System for Information on Grey Literature in Europe (OpenGrey) (January 1995 to 31 December 2014), BIOSIS (January 1926 to 5 May 2014), Scopus (January 1966 to 31 December 2014), Japan Science and Technology Institute (J-Global) (January 1975 to 31 December 2014), China National Knowledge Infrastructure (CNKI) (January 1979 to 31 December 2014), British Library's Electronic Table of Contents (Zetoc) (January 1993 to 7 May 2014)...
2015: Cochrane Database of Systematic Reviews
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